Infection Rates Drive High Costs, Health Care Resource Utilization Among Patients on Dasatinib
Patients treated with dasatinib for newly diagnosed chronic myeloid leukemia (CML) experienced greater health care resource utilization (HRU) and associated costs due to infection than patients treated with nilotinib, according to research presented at the 59th American Society of Hematology Annual Meeting & Exposition (December 9-12, 2017; Atlanta, GA).
Treatment with second-generation tyrosine kinase inhibitors (TKIs) has become the standard of care for patients with Philadelphia chromosome–positive CML. However, these therapies carry a high risk for infection, potentially due to the immunosuppressive effects of treatment. Few studies have addressed the HRU and costs associated with TKI treatment in this population.
Karen Seiter, MD, professor of medicine at New York Medical College (Valhalla, NY), and colleagues conducted a retrospective study of patients with newly diagnosed CML, treated with dasatinib or nilotinib beginning on or after October 2010. To determine HRU and costs, they observed inpatient (IP) days, emergency department (ED) visits, and days on outpatient (OP) services.
The study included data from 1156 patients treated with dasatinib and 677 patients treated with nilotinib (mean age, 52 years; 54% men). Both groups had similar mean TKI therapy duration (dasatinib, 13.6 months; nilotinib, 15.5 months).
In total dasatinib patients experienced a greater number of all-cause IP days (2.7 vs 1.3; adjusted incidence rate ratio [IRR], 1.9; P = .003) and IP days related to infections (1.4 vs 0.6; adjusted IRR, 2.1; P = .020). Dasatinib patients further experienced 30% more all-cause ED visits (adjusted IRR, 1.3; P = .041) and a doubling of infection-related ED visits (adjusted IRR, 2.1; P < .001).
The researchers observed no statistically significant differences between dasatinib and nilotinib patients with regard to all-cause OP services days (27.5 vs 26) or days related to infection (1.6 vs 1.5).
The average annual all-cause cost of dasatinib was $157,767, of which 7% ($10,943) was related to infections. Nilotinib had an annual cost of $136,290, of which 6% ($7620) was related to infections. Dasatinib patients incurred significantly higher all-cause medication costs (adjusted difference, $17,265; P = .004) and infection-related costs (adjusted difference, $6572; P = .004); the average TKI costs related to infection were $9637.—Cameron Kelsall